In December 2019, the NSW Paediatric Rehabilitation Model of Care document was released, highlighting the absence of a consistent approach to using telehealth services to support rehabilitation care close to home. Whilst telehealth had been offered to some families (with a focus on rural families) in the past, it was acknowledged that this was ad hoc. Additionally, families closer to paediatric services were rarely offered telehealth despite well-known challenges such as traffic, parking and navigating hospitals.
Providing care close to home
To address the gaps and inconsistencies in paediatric rehabilitation services across NSW, a Telehealth Working Party was established in January 2020, compromising of staff and consumers from across all three paediatric rehabilitation sites. There was a strong focus on providing informed choice to families and fostering a collaborative decision-making process between families and clinicians.
In-line with the objective of the NSW Paediatric Rehabilitation Model of Care review of providing ‘care close to home’, this project aimed to develop a consistent approach to using telehealth across all paediatric rehabilitation services in NSW. It aimed to increase telehealth access, usage and experience for both consumers and clinicians by focusing on:
- giving all families a choice about their appointment modality
- including clinical decision-making in this process
- the development of resources
- measuring patient experience.
Implementing a telehealth model
NSW Health’s Quality Improvement Data System (QIDS) was used to capture and collate all information and resources for the project. An iterative implementation approachwas used, testing small changes and reviewing frequently using the Plan-Do-Study-Act framework.
Early on, a survey to investigate rehabilitation patient families experience with telehealth was developed by the working party with the network’s PREMS Project Officer. This was piloted before being implemented more widely across the Sydney Children’s Hospital Network only (it could not be implemented at HNEkidsRehab). Families now have an opportunity to complete this survey at the end of all telehealth consultations, with data collated on a dashboard.
For consistency and ensuring equity of service provision, it was deemed important that all families were provided with information about, and consideration for use of telehealth for their appointments. Processes and resources were developed, tested, and revised in order to make this feasible for families and staff, as well as clinically appropriate. Final resources include:
- A letter template sent with all appointment letters providing families with a prompt to call the relevant department to discuss whether telehealth may be appropriate for them.
- Information sheets for families outlining the benefits of telehealth and what technology and equipment is needed.
- Age specific information sheets to enhance consumers skills in setting up the physical environment and promote engagement.
- A consideration tree for clinicians to refer to when discussing with families whether telehealth would be appropriate.
Patients feel more involved in decision-making
The processes and resources developed have generally been adopted by Kids Rehab and Rehab2Kids. Overall, the project was well received by staff and consumers. According to patient experience survey data, nearly 97% of respondents reported that they had an overall good experience with telehealth for their rehabilitation appointment. They reported feeling involved in decision-making, feeling respected and clearly communicated with. They were happy with the care they received and were mostly content to be guided by their clinicians as to the appropriateness of using telehealth again in the future.
Staff feedback collected over a three-month period indicated a level of burden that required addressing. Overall, a low number of families called Kids Rehab or Rehab2Kids to discuss changing their appointment (10% of all appointments). Of those that did, 85% ultimately changed their appointment from face-to-face to telehealth, indicating a high level of clinical appropriateness for those that did call. However, this process took on average 12 minutes of administrative and clinical time per phone call. This was felt to be too much time for some staff. Changes to the processes for certain services to reduce staff burden have been made, but families continue to be offered information and choice.
